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Sub-classification of Advanced Stage Hepatocellular Carcinoma based on a Real-life Cohort
( Jeong-ju Yoo ),( Jeong-hoon Lee ),( Young Chang ),( Eunju Cho ),( Su Jong Yu ),( Yoon Jun Kim ),( Jung-hwan Yoon ),( Seoul Liver Group ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Advanced Hepatocellular carcinoma (HCC) embraces various clinical conditions: major vessel invasion, extrahepatic metastasis, and poor performance status. The aim of this study was to establish a prognostic scoring system using independent factors and to propose sub-classification of Barcelona-Clinic Liver Cancer (BCLC) stage C. Methods: This retrospective study included consecutive patients who received sorafenib for BCLC stage C HCC at a single tertiary hospital in Korea. Factors affecting overall survival were analyzed. Cox proportional hazard model was used to develop a point score system, and internal validation was performed by 5-fold cross-validation. The performance of model to predict risk was assessed by area under the curve (AUC) and Hosmer-Lemeshow test. Results: Among 756 patients who received sorafenib for HCC between 2008 and 2014, 612 (81.0 %) were classified as BCLC stage C and included in this study. Mean age of the patients were 60.3±10.7 and 84.2% were male. The patients were further classified into strata depending on their performance status (ECOG 0 or 1). Five independent prognostic factors (Child-Pugh score, alpha fetoprotein, tumor type, extrahepatic metastasis, and portal vein invasion) were identified and used in the prognostic scoring system. The scoring system gave from one to ten points for the presence each factor, resulting in a total score ranging from 0 to 24 (Table 1). This scoring system showed good discrimination (area under time-dependent ROC curve [AUC]=0.734-0.818) and calibration functions. (Figure 1) Cases were analyzed in the three risk groups according to the total score. In internal validation, AUC was similarly maintained (0.734 at month 12). Conclusions: The result of heterogeneity of patients with BCLC stage C HCC requires sub-classification of advanced HCC. The prognostic scoring system using five independent factors is useful in predicting the survival of patients with BCLC stage C HCC.
폐암환자에서 발생한 Clostridium difficile 대장염의 임상적 특성
( Chul Park ),( Ki Eun Hwang ),( Do Sim Park ),( Yu Ri Hwang ),( Chang Hwan Seoul ),( Hak Ryul Kim ),( Eun Taik Jeong ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Background/Aims: In lung cancer patients, antibiotics commonly used for prophylactic or therapeutic purposes due to high risk of pneumonia, which can be caused by neutropenia during chemotherapy or immunosuppressive conditions. This study investigated the clinical characteristics of lung cancer patients having CDC (Clostridium difficile colitis) during chemotherapy. Methods: Among 263 patients who were diagnosed for lung cancer with lung biopsy and had chemotherapy between January 2009 and December 2010 in Wonkwang university hospital pulmonary department, 170 patients were divided into two groups (CDC positive and negative group) and their clinical aspects were surveyed. The study examined the medical records of 170 lung cancer patients through retrospective analysis. Results: There was no correlations between CDC negative and CDC positive groups in age, sex, underlying disease, histological type, stage of the lung cancer, serologic analysis, and the type of chemotherapy. CDC positive group had significantly higher PS scores compared to the negative group, with relatively low activity of daily living (p<0.05). In CDC positive group (n=26), 24 patients (92%) were using antibiotics, and showed their symptom 15.6 days after the administration of antibiotics. Most patients had abdominal pain (n=20, 77%) and diarrhea (n=18, 69%), whereas 6 patients simply showed abdominal pain without diarrhea. 20 patients had clinical improvement after metronidazole or oral vancomycin administration. However, 4 patients died from progression to sepsis. Conclusion: Lung cancer patients having chemotherapy and antibiotics treatment showed significantly higher risk of CDC as their activities of daily living got lower. Therefore, it is important to suspect and diagnosis CDC in lung cancer patients with simple abdominal pain or increase of CRP level during chemotherapy even though they do not have specific symptoms.